Saving lives, saving life

In any cloud of angel investors, the one with the biggest, whitest, fluffiest wings is likely to be Jaan Tallinn, Estonian physicist, entrepreneur, tycoon and big thinker.   

Since BQ’s launch, this writer has rarely met a Baltic business person who did not aspire to emulate the success of Skype, the voice-over-internet titan that Tallinn’s code-writing genius helped to found. While that company has become a universal brand, whose global impact remains the beacon of all Baltic business, those who know anything about Jaan Tallinn, 43, personally are in awe of the skill and humility with which he and his colleagues have handled their good fortune since first becoming a global household name, and before being sold to eBay in 2005 for an estimated $3bn, then to Microsoft in 2011 for $11bn.

It is therefore a great privilege for this magazine to catch up with the Alexander Graham Bell of our age to hear about his post-Skype angel activities. It is an even greater pleasure to find him as down-to-earth and modest as fellow Estonian tech entrepreneurs have told me that he is, refusing to accept, for example, that he is a walking symbol of Estonia’s extraordinary reputation for innovation and “smart” 21st century living.

BQ Baltic encounters Tallinn on a rainy day in London, where he has been addressing a conference, something he is regularly asked to do throughout the world. Tallinn is now a global authority in the field of artificial general intelligence (AGI), the still hypothetical phenomenon in which computers are able to assume all of the intellectual capabilities of humans, including reasoning, forward planning, and learning and thus are enabled to override any of the controls with which we currently keep them in check. If and when this happens, human capacity to control the process will be hopelessly inadequate.

This may sound like an eccentric sci-fi obsession, but Tallinn is deadly serious about the potential for the computer “intelligence explosion” disaster in which – in the most famous example ”a machine designed to optimise the production of paperclips, turns the whole world into paperclips”.

Computer intelligence running amok and inadvertently destroying life on earth (he doesn’t hold with “anthropomorphic nonsense” about computers turning malevolent), is just one of the issues that Tallinn grapples with at the recently founded Cambridge Centre for the Study of Existential Risk, in the distinguished company of the philosopher Prof Huw Price and the astrophysict Sir Martin Rees.

Most of Tallinn’s time, however, is spent in the city he share’s his name with (he has six children based there), and the rest either globetrotting or in New York, where the main object of his current interest as an investor and mentor is based.

MetaMed, a healthcare company in New York, is a potentially revolutionary new “personalised medicine” service, with the power to transform how we think of ourselves as “consumers” of health service, and to disrupt something far older and more fundamental even than traditional fixed-line telephony – the relationship between patients and their medical practitioners.  

“I deal with quite a lot of companies as an angel investor,” Tallinn tells me. “And then there are a few companies that I feel more interested in and MetaMed is probably my main interest along with communications software, which is messaging communications software, invented by fellow ex-Skype engineers”.

The main vehicle for Tallinn’s investment largesse and technical and business advice used to be Ambient Sound Investments, but he hints that the seed investment company is not the tech innovation powerhouse that it once was.

“We formed the company together with all four founding engineers from Skype and we have discovered that we are fairly different in our attitude towards VC or angel investment. In practice we end up doing sort of common-denominator investment, buying shares in public companies or buying real estate, things like that. The other technology angel investment we tend to do privately.”

“MetaMed is probably the most important company that I have invested money in and invested my time in but we have just got a new CEO in August and I want to give him some room.

“I would not want to be messing around with the company while he is just getting started.” The new chief executive is Dutchman Walter Hoogland. “He’s a doctor himself, which is nice.”

“He seems to be doing a good job. My job is to advise him but not try to manage the company directly. One of his first priorities is to come up with new solutions for the website and our marketing material.”

Skype02It’s a long leap from telecommunications to medical research, which suggests that Tallinn’s success and his status has prompted the kind of soul-searching about what matters most that very few of us have the chance to undertake.

“I kind of realised that my resources are money and time. Money is a more flexible resource. Time is an inflexible resource because there’s a finite amount of it.”  

This is the closest that Tallinn gets to a reference to the great wealth and freedom that the Skype sale has brought him and his partners.  

“You cannot invest time and get more time out of it. Well you sort of can but .. anyway,
I tried to invest my time in areas where I would be creating something that is more valuable than money. And by that I mean I wanted to create things you just can’t buy with more money.”

In the case of MetaMed this means a chance of extended or improved life for people suffering from chronic or apparently terminal conditions.“MetaMed is a really prime example of that. The people behind MetaMed basically identified what everyone, kind of anecdotally knows – that the medical system in the US is horribly, horribly broken.”

Tallinn also describes it as the professionalisation and validation of a service that already exists in a very crude and sometimes dangerous form to anyone with internet access; self diagnosis and self-treatment through the internet, an obvious minefield to those without the qualifications to interpret the results.

“People who are sick are going to the internet and doing their own research when they have medical problems, so one way of presenting what we do is as a professional version of
that. We have access to specialist university research literature, and we have access to additional resources.”

The reason that they do this is because, in the US at least, the strong correlation between your health and your wallet is now one of the greatest social and political issues of modern times.

“Sure if you are a patient and if you have the means you can just spend more money and get to places like the Mayo Clinic [the top flight facility in Minnesota]. However, there are still systematic problems that prevent you from getting the treatment that is right for you.”

“One way of putting it is that there is a certain body of knowledge that humanity has about the human anatomy and how to basically cure illnesses. And then there is a subset of that which is about putting it into practice.” MetaMed exists to ensure that the sum of human knowledge about a health condition can be accessed by the person suffering from
that condition.

“There are various reasons why the whole body of knowledge does not get put into practice but the main one is that there are no strong incentives for the system to kind of adopt new breakthroughs in research as quickly as possible.”

“The incentive systems are somewhat strange. Let’s just say that they are not perfectly aligned with what patients need. If you look at the system with enough perspective, you see that the US system really is in the business of selling treatments in a way that serves the interests of the insurance companies. Whether people get better or worse is not the main concern.

“The incentives that pharmaceutical companies have are perverse. When they start investigating in a new drug, a potential drug, in a perfect world they would be brutally honest about whether it works or not and if it doesn’t, to cut it short as quickly as possible. However, once they have advanced it through all their different stages of trials, they have made a major investment in it, and they are going to treat this investment more gently…”
He seems to be hinting that they will want to market this drug, even if they know it is not
all that effective.

“If true, it certainly suggests that the US health system itself is fundamentally sick. But how is MetaMed the cure?

“We have basically two core ideas. One is that we want our incentives perfectly aligned so we get our income directly from our customers, that is the patients. We do not take money from insurance companies and we do not represent pharmaceutical companies. We are a perfect ‘first line’ company”.

“The other thing is that we want to treat medical problems as client’s problems, so
you have people who are actually qualified to look into medical literature, who can assess the soundness of that. They can dig up whatever evidence there is from the latest medical literature that is true and relevant to the patient”.

“We are empowering the patients and empowering the success of their treatment programme. The success of our treatments directly affect our income. We are selling to the market of customers who want to improve their healthcare.”

“The way it works is that first we perform an intake assessment. The patient talks to a team composed of a doctor, a case manager and a patient representative. Together they come up with a research plan that includes a menu of investigations that we can offer. They all have associated budgets. And once the client approves one or more of those items of research they come back with a research report. Then, together, we figure out what the next step should be and how we can assist with these steps. Eventually we have regular follow-ups with the client.”

MetaMed’s services are directed to those in the unhappy situation of having hard to diagnose or complex health problems, making it – to put it crudely – a kind of last chance option available to those with access to the means.

“The majority of our clients are either terminally ill, or they have some serious chronic condition that they have not been able to have treated by the medical system.
“We have had clients who had a rare sleep disorder but who were perfectly healthy otherwise – but we were able to help with the sleep disorder.”

“I think we can provide value for anyone who who has some medical problems, though clearly we get a lot of people who are highly motivated because they are desperate for any help they can get.”

So far MetaMed has helped more than 60 patients, with the amount they pay for the service varying widely.

“We have been experimenting with a pricing scheme. Currently during the intake process, we brainstorm and put together the research plan, and gather the data, all of which costs about $5,000.

“Then we come back to the research plan which is dependent on how deep the client wants to go, and how complex the research looks. Our typical research plan is about $20,000. However, we have had cases where it has cost up to $250,000.

“We have about 50 people on the staff – when I did a count a year ago there were 30 researchers and 20 doctors.”

Given the power of the combined vested interests who might see this patient-centric system as a challenge, I ask Tallinn if there has been any sign of resistance from any in the pharmaceutical, medical, insurance or legal establishments who might like to nip in the bud a phenomenon capable of short-circuiting the labyrinthine current system, which may not serve patients very well, but is in many ways highly lucrative for those who service them.

He thinks not. “First of all we are a fairly small start up so I do not think we have yet registered on any big players’ radar.”

“But yes, when we do talk to doctors, sometimes they get defensive about the status quo, because doctors themselves know that the system they are working in isn’t perfect. One way of putting it is that doctors do not think that the system is perfect but they still think that they are the ones who should be in charge of it!”

“That said, we have taken a more collaborative approach with medical practioners recently and, in fact, we are working with several doctors in the US and UK to work as a back office to them. We want our service to empower the doctors in a new way, to offer our research capability as a kind of outsourced service to them.”

“Some doctors at the top of their profession have pretty demanding clients so they are faced with the choice of whether they do a lot of research themselves, or find someone to
do the research, or basically turn to us, and have a team that already knows how to do such research.”

The US healthcare system is a world on its own, characterised by complexity and strange dynamics. Does Tallinn think the MetaMed model is transferable, and will work anywhere in the world?.

“Yes absolutely, but the US health care systems, in terms of price performance, is about twice as bad as the European ones. I think that the contrast that MetaMed can provide in the US is much more dramatic than in Europe, though we do have European clients.”

One early indication of how successful MetaMed is likely to be is the amount of imitators it has. Tallinn is such a high profile investor, so one would expect others to follow where he leads.

“It depends on how widely you draw the line to define imitators,” he says. “There are a lot of companies who are basically providing a service of a second opinion, or providing a service of access to specialists.  I even have a few investments with other medical companies whose strategy is to provide complementary services. There’s one investment I have in New York called RubiconMD, which is basically a network of specialists.”

“I don’t think there are great direct competitors yet, meaning competitors who are really trying to solve medical issues with scientific research. However, there are a lot of companies that are basically disaggregating doctors in one way or another.”

All of this is a world away from software creation for Tallinn, who studied theoretical physics at Tartu University.

But he still keeps one foot firmly in that discipline with his support for Fleep, a B2B messaging application, with roots in the Estonian Skype organisation as a parallel instant messaging function, but which fell by the wayside as the Skype phenomenon took off
in other directions.

“Because Skype’s messaging service was used extensively as an internal tool this generated a massive amount of ideas about how to improve it – we could see the bottlenecks and short cuts.  Tallinn’s support for Fleep has involved him dabbling in his first love – code writing.

He says: “I wrote some code for, recently. I really like coding so every once in
a while I find some high value project that I can get involved in.”

“The interesting thing about Skype was that Skype engineering was run on Skype IM [instant messaging] – all the engineering discussions and all the interesting communications ran on Skype chatrooms, not the voice chatrooms.”

“At some point I took a group of high end engineers from Skype, which was owned by Microsoft by then, and they decided to do their own start up. They took the approach that, OK, time has moved on, there are all these new ideas about how to do IM properly, and  they just basically went for it.

So now it’s a multi-platform service – you should check it out. It works on all major platforms, Android, Mac and Windows.

“It definitely has the potential to become as big as Skype, but the interesting thing is that,  with Skype and Microsoft, the bulk of their code was written for [old-style] computing environments, essentially a big computer plugged into the wall.

For that reason, while the code is sub-optimal for mobile communications they can’t just start anew because they have this massive backwards compatibility requirement. TVs out there expect to receive Skype calls, so we can’t just kill them all and start again.”

“In that sense Fleep and other upstarts – such as WhatsApp, also other Skype competitors – are in a much better position to adjust to the current environment, because they started later.

“Fleep obviously doesn’t have the disadvantage of having to match the existing network, so yes, it stands a good chance”.

And with that, Tallinn signs off, leaving me to reflect on what he has achieved. First he helped obliterate the world’s great distances by realising the long-held futuristic dream of cheap and easy video communication. From transforming lives, it is not such a big leap
for him to move into the realm of saving lives, and, who knows, if he can devise a way to prevent computers from getting ideas above their station, of saving life itself.

Published: 17 December 2014

Article by Colin Donald
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